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Trends in the States: First Quarter 2015

First published online: April 2, 2015

By the end of the first quarter of the year, legislators had introduced 791 provisions related to sexual and reproductive health and rights. Nearly 42% of these provisions (332 provisions) seek to restrict access to abortion services; abortion restrictions have been introduced in 43 states. By April 1, 53 abortion restrictions had been approved by a legislative chamber, and nine had been enacted. Many of the new abortion restrictions enacted this year would either limit the use of medication abortion (Arkansas and Idaho) or ban abortion at 20 weeks postfertilization (West Virginia), a disturbing combination of attempts to curtail access in both the early and later months of pregnancy, potentially leaving women with fewer options and a greatly reduced time frame to get the care they need.

Abortion opponents’ assault on medication abortion, a procedure that likely has helped women obtain abortion care earlier in pregnancy and now accounts for nearly one-quarter of all non-hospital abortions, is continuing apace in 2015. So far this year, Arkansas enacted a new law requiring abortion providers to follow the outdated protocol included in the FDA-approved labeling for medication abortion that is more expensive, carries a higher risk of side effects, and requires more clinic visits than does the widely used evidence-based protocol; in addition, the FDA regimen can only be used during the first 49 days of pregnancy, compared with 63 days for the evidence-based protocol. North Dakota, Ohio and Texas have similar laws (see Medication Abortion).

In addition, Arkansas adopted two measures banning telemedicine for medication abortion; one was an independent bill and the other was included in the state’s law governing the use of telemedicine in general. Idaho enacted a similar ban on using telemedicine for abortions bringing to 18 the number of states that ban the use of telemedicine for the procedure (see Medication Abortion).

At the same time, several states are also moving toward restricting access to abortion services later in pregnancy. The West Virginia legislature overrode a veto by Gov. Earl Ray Tomblin (D) to enact a ban on abortion starting at 20 weeks postfertilization; similar measures are pending in seven other states. Including West Virginia, 14 states ban abortions at 20 weeks postfertilization (see State Policies on Later Abortions). In addition, several states are considering a new type of restriction that uses graphic terminology in an attempt to limit how a second-trimester abortion can be provided. These measures, which are designed to ban most abortions after the first trimester, have been approved by both chambers of the Kansas legislature, one chamber in Oklahoma and are pending in Missouri and South Carolina. (Kansas Gov. Sam Brownback (R) is expected to sign his state’s measure in early April.)

Legislators in 21 states have introduced 43 provisions seeking to impose targeted regulations on abortion providers (see TRAP). Two states have enacted new provisions. Arkansas enacted two provisions, a measure that requires specific and costly procedures for the disposal of fetal remains and a requirement that medication abortion providers have admitting privileges at a local hospital. Arizona enacted a measure that tightens requirements related to abortion providers’ admitting privileges. Additional measures passed by one legislative chamber in four states seek to make existing TRAP requirements more stringent by increasing inspection requirements (Missouri and Oklahoma); permitting the state to deny a clinic license if a previous license was revoked, suspended or terminated for any reason including administrative (Texas); and expanding the laws’ reach to physicians who provide five or more abortions annually in their private offices (Indiana).

Finally, legislators in 16 states have introduced state versions of the Religious Freedom Restoration Act (RFRA). The U.S. Supreme Court relied on the federal version of the law in its decision in Burwell v. Hobby Lobby to justify permitting businesses to refuse to provide contraceptive coverage. Indiana Gov. Mike Pence (R) signed the bill mirroring RFRA into law in late March, provoking an enormous public outcry. (The outcry has led the Governor and the legislature to reevaluate the law.) Both chambers of the Arkansas legislature and one chamber in Georgia and Wyoming have passed similar measures. Notably, the uproar over these measures has centered on their potential to sanction discrimination against gay individuals. However, the potential impact on contraceptive coverage—and reproductive health more broadly—has received little, if any, attention.

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